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The lifetime risk of suicide in schizophrenia: a reexamination.
Arch Gen Psychiatry. 2005 Mar; 62(3):247-53.AG

Abstract

BACKGROUND

The psychiatry literature routinely quotes a lifetime schizophrenia suicide prevalence of 10% based on 1 meta-analysis and 2 studies of chronic schizophrenics.

OBJECTIVES

To build a methodology for extrapolating lifetime suicide prevalence estimates from published cohorts and to apply this approach to studies that meet inclusion criteria.

DATA SOURCES

We began with a MEDLINE search (1966-present) for articles that observed cohorts of schizophrenic patients. Exhaustive bibliography searching of each identified article brought the total number of articles reviewed to 632.

STUDY SELECTION

Studies included in the meta-analysis observed a cohort of schizophrenic patients for at least 2 years, with at least 90% follow-up, and reported suicides. Articles are excluded for systematic age bias (ie, adolescents).

DATA EXTRACTION

Extracted data included sample size, number of deaths, number of suicides, percentage of follow-up, and diagnostic system used. Data were extracted independently by 2 of us, and differences were resolved by consensus after re-review.

DATA SYNTHESIS

Studies were divided into 2 groups: 32 studies of schizophrenics enrolled at various illness points (25 578 subjects) and 29 studies of schizophrenics identified at either illness onset or first admission (22 598 subjects). Regression models of the intersection of proportionate mortality (the percentage of the dead who died by suicide) and case fatality (the percentage of the total sample who died by suicide) were used to calculate suicide risk in each group. The estimate of lifetime suicide prevalence in those observed from first admission or illness onset was 5.6% (95% confidence interval, 3.7%-8.5%). Mixed samples showed a rate of 1.8% (95% confidence interval, 1.4%-2.3%). Case fatality rates showed no significant differences when studies of patients diagnosed with the use of newer systems were compared with studies of patients diagnosed under older criteria.

CONCLUSION

This study estimates that 4.9% of schizophrenics will commit suicide during their lifetimes, usually near illness onset.

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Authors+Show Affiliations

Palmer BA
Mayo Medical School, Department of Health Sciences Research, Rochester, Minn, USA.
Pankratz VS
No affiliation info available
Bostwick JM
No affiliation info available

MeSH

Age of OnsetCause of DeathCohort StudiesConfidence IntervalsCross-Cultural ComparisonFollow-Up StudiesHospital MortalityHospitalizationHumansNonlinear DynamicsOdds RatioPrevalenceRegression AnalysisRisk FactorsSchizophreniaSchizophrenic PsychologySuicide

Pub Type(s)

Comparative Study
Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15753237

Clinical Trial Links

Normobaric Oxygen Therapy for Individuals With First-Episode Psychosis

Citation

Palmer, Brian A., et al. "The Lifetime Risk of Suicide in Schizophrenia: a Reexamination." Archives of General Psychiatry, vol. 62, no. 3, 2005, pp. 247-53.
Palmer BA, Pankratz VS, Bostwick JM. The lifetime risk of suicide in schizophrenia: a reexamination. Arch Gen Psychiatry. 2005;62(3):247-53.
Palmer, B. A., Pankratz, V. S., & Bostwick, J. M. (2005). The lifetime risk of suicide in schizophrenia: a reexamination. Archives of General Psychiatry, 62(3), 247-53.
Palmer BA, Pankratz VS, Bostwick JM. The Lifetime Risk of Suicide in Schizophrenia: a Reexamination. Arch Gen Psychiatry. 2005;62(3):247-53. PubMed PMID: 15753237.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The lifetime risk of suicide in schizophrenia: a reexamination. AU - Palmer,Brian A, AU - Pankratz,V Shane, AU - Bostwick,John Michael, PY - 2005/3/9/pubmed PY - 2005/3/22/medline PY - 2005/3/9/entrez SP - 247 EP - 53 JF - Archives of general psychiatry JO - Arch Gen Psychiatry VL - 62 IS - 3 N2 - BACKGROUND: The psychiatry literature routinely quotes a lifetime schizophrenia suicide prevalence of 10% based on 1 meta-analysis and 2 studies of chronic schizophrenics. OBJECTIVES: To build a methodology for extrapolating lifetime suicide prevalence estimates from published cohorts and to apply this approach to studies that meet inclusion criteria. DATA SOURCES: We began with a MEDLINE search (1966-present) for articles that observed cohorts of schizophrenic patients. Exhaustive bibliography searching of each identified article brought the total number of articles reviewed to 632. STUDY SELECTION: Studies included in the meta-analysis observed a cohort of schizophrenic patients for at least 2 years, with at least 90% follow-up, and reported suicides. Articles are excluded for systematic age bias (ie, adolescents). DATA EXTRACTION: Extracted data included sample size, number of deaths, number of suicides, percentage of follow-up, and diagnostic system used. Data were extracted independently by 2 of us, and differences were resolved by consensus after re-review. DATA SYNTHESIS: Studies were divided into 2 groups: 32 studies of schizophrenics enrolled at various illness points (25 578 subjects) and 29 studies of schizophrenics identified at either illness onset or first admission (22 598 subjects). Regression models of the intersection of proportionate mortality (the percentage of the dead who died by suicide) and case fatality (the percentage of the total sample who died by suicide) were used to calculate suicide risk in each group. The estimate of lifetime suicide prevalence in those observed from first admission or illness onset was 5.6% (95% confidence interval, 3.7%-8.5%). Mixed samples showed a rate of 1.8% (95% confidence interval, 1.4%-2.3%). Case fatality rates showed no significant differences when studies of patients diagnosed with the use of newer systems were compared with studies of patients diagnosed under older criteria. CONCLUSION: This study estimates that 4.9% of schizophrenics will commit suicide during their lifetimes, usually near illness onset. SN - 0003-990X UR - https://www.unboundmedicine.com/medline/citation/15753237/The_lifetime_risk_of_suicide_in_schizophrenia:_a_reexamination_ L2 - https://jamanetwork.com/journals/jamapsychiatry/fullarticle/10.1001/archpsyc.62.3.247 DB - PRIME DP - Unbound Medicine ER -